Peripheral Artery Disease: Leg Pain When Walking, Risk Factors and When to Be Seen

What it involves

MedlinePlus explains that peripheral artery disease, or PAD, is a condition in which the arteries that supply the legs and feet become narrowed, usually by a buildup of fatty material called plaque. That decreases blood flow and can injure the skin, muscles, nerves, and other tissues.

Who this is for

• Patients with aching, cramping, or heaviness in the calves, thighs, or hips when walking that eases with rest
• Patients with diabetes, high blood pressure, high cholesterol, or a history of smoking who notice leg symptoms
• Patients with a sore on the toe or foot that is slow to heal
• Patients with one leg that feels colder or looks paler than the other

What to expect

• Questions about when leg pain starts, how far you can walk, and what relieves it
• A look at the legs and feet and a check of the pulses, since MedlinePlus lists weak or absent pulses among the findings
• A discussion of risk factors such as smoking, blood pressure, cholesterol, and blood sugar
• Circulation testing or a referral to a vascular specialist if a provider suspects PAD

The pattern that points to PAD

MedlinePlus says the main symptoms are pain, achiness, fatigue, burning, or discomfort in the muscles of the feet, calves, or thighs, usually during walking or exercise, that go away after several minutes of rest. At first it may appear only uphill or on longer walks. Over time it comes on sooner. Many people with PAD have no symptoms at all, according to the MedlinePlus health topic page, so the absence of pain does not rule it out.

Signs in the legs and feet

Beyond pain, MedlinePlus lists legs that feel cool to the touch, pale skin, and numbness at rest. As PAD becomes more severe it names night pain and cramps, pain or tingling in the feet and toes, skin that looks dark and blue, and sores that do not heal. Hair loss over the legs, thick toenails, shiny tight skin, and shrinking calf muscles can be found on an exam. Foot sores in people with diabetes are covered in the diabetic foot care guide.

Who is at higher risk

MedlinePlus says PAD is common, most often affects men over age 50, and can occur in women too. It lists diabetes, coronary artery disease, high cholesterol, high blood pressure, kidney disease involving hemodialysis, smoking, and stroke as risks, and calls smoking the main one. The practice's pages on blood pressure care, cholesterol care, and diabetes care cover the risk factors that can be managed.

How it is checked

MedlinePlus says a provider may find a whooshing sound over an artery, lower blood pressure in the affected limb, or weak or absent pulses. Tests for PAD it lists include comparing blood pressure in the arms and legs, called the ankle-brachial index, a Doppler ultrasound, and imaging such as MR or CT angiography. Those tests are typically arranged by a provider or specialist. It also notes that no screening test is recommended for people without symptoms.

What can help

MedlinePlus lists stopping smoking, balancing walking with rest, caring for the feet, controlling blood pressure, cholesterol, and blood sugar, and keeping a healthy weight. It says always to talk to the provider before starting an exercise program. Medicines may include aspirin or clopidogrel to keep blood from forming clots, and it warns not to stop them without talking to a provider. Procedures to open or bypass a blocked artery are done by specialists when PAD is severe.

When to act quickly

MedlinePlus advises contacting a provider if a leg or foot becomes cool, pale, blue, or numb, if there is leg pain at rest, if new sores appear, or if there are signs of infection such as fever and redness. Chest pain or shortness of breath with leg pain needs urgent attention, and the chest pain guide explains when to call 911. A swollen red leg is a different problem, covered in the leg swelling guide.

Sources

• MedlinePlus — Peripheral artery disease, legs
• MedlinePlus — Peripheral Arterial Disease